Chemical peels have been a reliable mainstays of the cosmetic physician's toolbox for well over a century. Trichloroacetic acid (TCA), Jessner's solution, salicyclic acid, glycolic acid and phenol have all been used in varying concentrations and protocols for treating acne scarring, pigmentary problems, wrinkles and other unwanted manifestations of photoaging for many decades before lasers came on the scene.
Although quite a number lasers and light treatments have come and gone in the past fifteen years, chemical peels have not only remained an important treatment tool, but have actually been experiencing a kind of renaissance. In experienced hands, they offer reliable and reproducible results.
Chemical peels are typically divided into three categories: light, medium and deep peels. Light peeling agents include low concentrations (10-25%) TCA, glycolic acid, salicylic acid and Jessner's solution. Light peels are good for skin maintenance, and for fading mild hyperpigmentation and softening very fine wrinkles. Light peels are accompanied by little downtime and make great lunchtime beauty fixes.
Medium peeling agents include TCA 50%, and Jessner's solution or glycolic acid 70% followed by 35% TCA. Medium peels can help with more stubborn pigmentation and more pronounced photoaging. They typically are associated with more prolonged healing times and downtimes of seven or more days.
Deep peeling often meant the use of a combination product known as Baker's Phenol. Deep peels were quite useful for more severe wrinkling and skin laxity, but entailed, much like surgery, nearly two weeks of downtime, required strong sedation to perform and possessed signicant risks for the developing permanent loss of skin pigmentation and even scarring.For this reason, despite its efficacy, deep peeling fell in considerable disfavor in the last twenty years.
Enter the "Punctuated Phenol Peel"--the most recent advance in chemical peeling technique, and one that is sure to put chemical peeling squarely back on the map and in competition with the more expensive, more heavily hyped laser and light-based therapies currently intensively marketed to consumers.
The procedure is simple, requires no sedation, and has little or no downtime. Using 88% plain phenol, fine lines and crinkles are treated in punctuated (i.e. fractionated or pixelated) fashion. Using a very finely pointed applicator, the chemical is applied in a serial spot fashion with each spot separated from surrounding treatment spots by approximately one-quarter inch. The use of serial spot coverage, rather than coverage of whole areas, allows for rapid recovery as healing takes place from the intervening non-treated areas. It is precisely the same rational for the use of fractional lasers.
The "Punctuated Phenol Peel" technique is a novel approach to rejuvenation that limits the overall potential for toxicity and downtime of traditional deep peels while constituting focal spots of more intense peeling. Wrinkle lines and crepeyness can be traced in this punctuated fashion, and treatment sessions can be repeated at monthly intervals if necessary until the desired result is obtained. When appropriate, hyperpigmentation and acne scarred areas may likewise be treated in a punctuated fashion.
Consultation with and treatment by an esthetic physician experienced in chemical peeling is an absolute must for determining the appropriateness of this novel approach for any particular situation.